Individual
STACY DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
609 E YOUNG AVE STE B12, WARRENSBURG, MO 64093-9609
(660) 747-2370
Mailing address
544 SE COUNTY ROAD Y, WARRENSBURG, MO 64093-8350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105568
LICENSE#
MO
Enumeration date
11/01/2006
Last updated
07/08/2007
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